For many years now, I've tried to describe, often in excruciating detail, a healthcare system which inflicts terrible hardships on the American people. We live in a country which accepts a neutered government, owned and paid for by lobbyists who lavish insurance industry campaign payola on compliant politicians.
In our nation, the political class is required to repay its masters who fund them, so these fine public servants do next to nothing to protect their constituents from insurance industry abuse. In such a thoroughly corrupt and broken system as ours, cancer patients are denied chemotherapy, senior citizens forego unaffordable medication, and young children are denied life-saving transplants. The rest of us, delay needed healthcare, because despite being insured, we know it's likely at the end of the day, we'll face huge bills--and bankruptcy. And of course, we're not even touching the 47 million uninsured.
Today, I'm sad to say, that I'm going to tell you about amputees denied limbs by the for-profit insurance industry.
You might want to watch this--or not.
This is a uniquely American story. It is yet another piece of our unspeakable American shame.
You might also want to begin this brief journey in the land of missing limbs by asking yourself, why does our political system tolerate such a deplorable state of affairs? Keep in mind an image of the neutered U.S. government--funded by you-know-who.
Americans who have undergone some type of amputation, such as an arm, leg, hand or foot, and children who are born with limb loss, face many obstacles in their recovery and in their daily routines. Not being able to pay for limb replacement to return to work or lead productive lives shouldn’t be among them. But in America, for many, it is.
Currently, due to insurance regulations, prosthetic care is out of reach for many amputees American citizens. Insurance plans routinely restrict, deny and eliminate coverage for prostheses. This is yet another uniquely American horror that the next Democratic president must address.
About a year ago, USA Today described in a sad article how insurers routinely and regularly turn down the most basic needs of amputees.
In the face of drastically reduced health insurance coverage for prosthetic care, the Amputee Coalition of America, the largest national non-profit educational and advocacy organization representing nearly two million amputees, is calling for federal legislation requiring health insurance companies to cover prosthetic care on par with other essential medical care.
"Increasingly we’ve seen health insurers drastically limit coverage for prosthetic care by imposing unrealistically low dollar caps and restrictions, even limiting coverage to one prosthesis ‘per lifetime,’" said Paddy Rossbach, President and CEO of the Amputee Coalition of America.
Please read this one more time, "one prosthesis per lifetime".
In return for premiums paid for Murder By Spreadsheet health insurance, consumers expect to be covered for catastrophic illness or injury. They expect that their monthly premiums will provide them with the most basic of care, including prostheses. But we know, this rarely, if ever happens.
You think things are bad for you? Imagine the life of an amputee. You say you can't fathom what these American citizens face. Please keep reading.
What follows are several stories about being an amputee in America. They were sent to me by Morgan Sheets, the director of advocacy of The Amputee Coalition of America
If after you read this, you want more information about H.R. 5615, the Prosthetic Parity Act, you should go the the Amputee Coalition of America web site.
Meet Lauren Stochmal:
Patty Stochmal is Lauren's mother.
Lauren Stochmal,is a 3 year old amputee
Background: Lauren lost her limb as a baby, following a viral infection. Lauren also has Down's Syndrome.
Insurance Company: Cigna
Coverage/Restrictions: Cigna pays about 60 percent of the cost, so Patti pays about $4,000 a year to replace Lauren's left leg to keep up with her rapid growth. The Stochmals have also accepted contributions from fundraisers and a charitable foundation to help cover their share of the costs. But as Lauren gets older, the cost of her replacement legs will go up, increasing the burden on her parents.
Meet Ulli Delmar, 58:
Background: Ulli lost her right leg more than three years ago, when a driver ran a stop sign and smashed into her car.
Insurance Company: Anthem
Coverage/Restrictions: In one year, she and her husband have paid $55,000 in out-of-pocket costs related to her artificial leg. They have used their retirement savings.
Meet Greg & Maura Grusse:
Parents of Rachel Grusse, a 15 year old amputee
Background: Rachel lost both of her legs when she was 16-months old due to a bacterial infection. She has to get a new set every year as she grows. She now needs new legs. Her parents are not sure how they will afford to continue providing care. They also worry what will happen when Rachel is no longer covered by their insurance.
Insurance Company: Anthem
Coverage/Restrictions: Prosthetic care was 100% covered, then it was 75%. It is now 50% with no out of pocket maximums.
Had enough yet? Proud to be an American?
Meet John DiMasso, 46:
Background: John lost his left leg three years ago in a motorcycle crash that killed his wife. His insurance company paid generously for the amputation surgery and rehabilitation. They also paid for his prosthesis.
John was advised to lose some weight to help improve his blood pressure and cholesterol levels. Unfortunately losing 35 pounds meant that the socket that attaches his artificial leg to his body no longer fit correctly. About the same time, his employer switched from Aetna to Healthnet as its insurance carrier.
He needs a replacement part to allow him to walk comfortably on his artificial leg, but the cost of the new socket alone is more than $5,000, meaning if he used his insurance coverage he wouldn't have anything left for future coverage of more expensive needs, such as a replacement leg.
He is forced to use an ill-fitting socket, which is putting pressure on his bones, making it uncomfortable for him to walk. This could also cause future health problems.
Insurance Company: Healthnet
Coverage/Restrictions: While Aetna covered all of his costs, the Healthnet policy included a $5,000 lifetime limit on all prosthetic needs. Healthnet has acknowledged that most of their plans carry a $5,000 lifetime limit on prosthetics.
Meet Evan Light:
At eight months old, Evan Light lost his mother in a tragic accident. While he survived, that is also the day he became a bilateral amputee.
Many people would think of Evan’s life as a tragedy. But his parents, his three older sisters and his brother, are too busy chasing Evan around as he plays and laughs, just like any other eight year old, to focus on the past. The challenge that does haunt the Light family is the harsh financial realities associated with maintaining Evan's level of care.
Because of restrictions on Evan's health insurance coverage, doctors are estimating that his parents will spend an average of $17,000-$22,000 a year for the next ten years in order to provide him with the appropriate prosthetic care a fast growing youngster requires.
Evan is just one example of tens of thousands of amputees across America whose health and quality of life are being impacted by insurance companies that have restricted or even eliminated coverage for prostheses.
Many insurance companies are imposing financial caps on coverage for prostheses. Some plans exclude coverage for repairs. Others have sold policies that state a covered person is allowed only one prosthetic limb per lifetime.
One limb per lifetime:
Imagine if you were fit with a pair of shoes as a toddler and were told you had to wear that same pair of shoes for the rest of your life. Even for a 25 or 50 year old adult, this expectation of one limb per lifetime is completely absurd. For growing children, it is a true national tragedy.
Children who have undergone some type of amputation or who were born with a limb difference face many obstacles in their recovery and in their daily routines. Not being able to pay for the limb they need to walk to school or to play with other kids shouldn’t be among them. But in America, it is.
When an individual discovers that prosthetic care is not covered, they may have to resort to using retirement or children's college savings to purchase a prosthesis in order to continue working. Some take mortgages out on their homes or try to get bank loans to get the prosthesis they need.
Never forget that in America, healthcare is not a right but a privilege.